Stress plays an important role in the etiology of multiple morbid and mortal outcomes among the living. Drawing on health paradigms constructed among the living augments our evolving knowledge of relationships between stress and health. Therefore, elucidating relationships between stress and both chronic and acute skeletal lesions may help clarify our understanding of long-term health trends in the past. In this study, we propose an index of "skeletal frailty," based on models of frailty used to evaluate the life-long effects of stress on health among living populations. Here, we assess the possible applicability of frailty to archaeological populations. The skeletal frailty index (SFI) is proposed as a methodological liaison between advances made by biological anthropologists studying relationships between stress and health among the living and bioarchaeologists studying stress and health among the dead. In a case study examining skeletal stress in Medieval London, the SFI is applied to nonmonastic (N = 60) and monastic (N = 74) samples. We used analysis of variance/analysis of covariance to compare SFI values between nonmonastic-monastic groups, sexes, and age cohorts. Results indicate higher lifetime morbidity among monastic groups. These results complement previous bioarchaeological findings on the same London populations, wherein lower risks of mortality and longer lifespans were observed for monastic populations. SFI data reflect the morbidity-mortality paradox observed in modern populations and accompany recent findings in bioarchaeology of variation in Medieval monastic and nonmonastic "health." Ultimately, this study demonstrates the SFI's utility in bioarchaeology, through its application of commonly assessed skeletal biomarkers, its ease of applicability, and its potential usefulness for assessing changes in skeletal health over time and across specific geographies.

To broaden bioarchaeological applicability of skeletal frailty indices (SFIs) and increase sample size, we propose indices with fewer biomarkers (2–11 non-metric biomarkers) and compare these reduced biomarker SFIs to the original metric/non-metric 13-biomarker SFI. From the 2-11-biomarker SFIs, we choose the index with the fewest biomarkers (6-biomarker SFI), which still maintains the statistical robusticity of a 13-biomarker SFI, and apply this index to the same Medieval monastic and nonmonastic populations, albeit with an increased sample size. For this increased monastic and nonmonastic sample, we also propose and implement a 4-biomarker SFI, comprised of biomarkers from each of four stressor categories, and compare these SFI distributions with those of the non-metric biomarker SFIs. From the Museum of London WORD database, we tabulate multiple SFIs (2- to 13-biomarkers) for Medieval monastic and nonmonastic samples (N = 134). We evaluate associations between these ten non-metric SFIs and the 13-biomarker SFI using Spearman’s correlation coefficients. Subsequently, we test non-metric 6-biomarker and 4-biomarker SFI distributions for associations with cemetery, age, and sex using Analysis of Variance/Covariance (ANOVA/ANCOVA) on larger samples from the monastic and nonmonastic cemeteries (N = 517). For Medieval samples, Spearman’s correlation coefficients show a significant association between the 13-biomarker SFI and all non-metric SFIs. Utilizing a 6-biomarker and parsimonious 4-biomarker SFI, we increase the nonmonastic and monastic samples and demonstrate significant lifestyle and sex differences in frailty that were not observed in the original, smaller sample. Results from the 6-biomarker and parsimonious 4-biomarker SFIs generally indicate similarities in means, explained variation (R2), and associated P-values (ANOVA/ANCOVA) within and between nonmonastic and monastic samples. We show that non-metric reduced biomarker SFIs provide alternative indices for application to other bioarchaeological collections. These findings suggest that a SFI, comprised of six or more non-metric biomarkers available for the specific sample, may have greater applicability than, but comparable statistical characteristics to, the originally proposed 13-biomarker SFI.

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Numerous bioarchaeological studies emphasize an increase in dental lesions associated with the transition to agricultural subsistence. Over the years, this diachronic trend has led to the conflation and oversimplification of specific dental indicators of oral health with broad subsistence strategies, emphasizing intergroup variation at the expense of intragroup variation. In order to explore such hidden variation, this metastudy uses published data from 185 archaeological sites to test the hypothesis that the prevalence of dental lesions (carious lesions, antemortem tooth loss, and periapical abscesses) among classified agricultural groups is higher than among hunter-gatherers. As a secondary hypothesis, this study also tests the association between climatic variables (temperature variation, altitude, and precipitation) and dental lesion prevalence. Our results show that, despite significant differences in the average prevalence of carious lesions between agricultural and hunter-gatherer populations, the variation in caries prevalence shows high overlap (170%) between subsistence patterns. Additionally, differences in the prevalence of antemortem tooth loss and periapical abscesses between agricultural and hunter-gatherer populations are not significant, showing even larger overlaps in prevalence ranges. Complementing the lifestyle analyses, climatic factors (mean temperature, annual temperature, and precipitation) are significantly correlated with the prevalence of specific dental pathological lesions and not others. Our results emphasize the need to reevaluate certain dental conditions as direct indicators of broad subsistence patterns, calling attention to the complex multifactorial pathogenesis of dental lesions and the nonlinear relationship between oral indicators of health and subsistence lifeways. It is often-but falsely-said that dental caries is a "disease of civilization." There is no human population that has completely escaped it.

The objective of this project is to assess skeletal frailty, as estimated using a skeletal frailty index (SFI), at the medieval Polish site of Kałdus to better evaluate the impacts of living and social environments on individuals within this urban­izing population. We assessed biological frailty in adults from the Global History of Health Project database. 11 skeletal and dentoalveolar biomarkers were selected as representative of childhood and adulthood frailty and aggregated into an SFI by summing their occurrence in each individual. Cumulative skeletal frailty scores were tabulated for each individ­ual and could range from 0 (no skeletal markers of stressors present) to 11 (all skeletal markers of stressors present) based on the presence or severity of lifetime stressors that altered their living bones. As many skeletal frailty markers correlate with age, SFIs were compared between individuals within specific age groups: 18–25 (n = 21), 26–35 (n = 31), 36–45 (n = 31), and >45 (n = 25) years. In the overall sample, SFI averaged 4.13 (range 0–9, sd = 1.98). Among males (n = 56), SFI averaged 4.45 (sd = 1.90; range 1–8); among females (n=52), it was 3.79 (sd = 2.03; range 0–9). SFI was lowest in the youngest age group, 2.38 (sd = 1.83; range 0–6) and highest in the oldest, 5.48 (sd = 1.50; range 2–9; p < 0.001). In these medieval skeletons, SFI distributions were significantly different between males and females only when accounting for age (p = 0.044), with females exhibiting higher mean frailty within each age group. Skeletal frailty, as estimated from biomarkers of skeletal stress, suggests these individuals were exposed to considerable stress throughout their lives. As Poland’s written history in the medieval period is sparse, assessing skeletal frailty provides an alternative way to under­stand the lives and experienced stressors of its inhabitants. Further research connecting skeletal frailty to burial context and isotopic evidence will illuminate connections of SFI with diet, lifestyle, and health in medieval Poland.

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